Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)‐Induced Liver Failure

Arylraj R, Webb K, Neuberger J:  Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)-Induced Liver Failure.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  91-100

Review Article

Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)‐Induced Liver Failure

Ramakrishnan Arulraj^1, Kerry Webb^1,2 and James Neuberger^1,3

Affiliations: ¹Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; ²Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK and ³Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK


ABSTRACT

Liver damage from acetaminophen toxicity, whether as a result of a deliberate attempt at self‐harm or as a consequence of therapeutic misadventure, may, if not promptly treated, lead to liver failure and, in the absence of transplantation, to death. Risk factors for the development of liver failure include primarily the amount ingested and time to treatment, but use of alcohol, either before or with the ingestion, age, nutritional state, and concomitant therapy are also implicated. Many of those who take an overdose have a history of previous deliberate self‐harm, previous psychiatric illness, substance abuse, and a poor social and employment background. Once liver failure has developed, treatment is supportive but, for some, liver transplantation remains the only therapeutic option, and the use of liver support devices and dialysis remains for the future. Criteria for transplantation in this setting are now well documented. However, because of the shortage of donors, there remain concerns about the optimal use of this scarce resource. Thus, as well as establishing the need for a transplant in the small space of time between presentation and the onset of irreversible complications that would render a transplant futile, the clinical team will need to make extensive enquiries from the patient (where possible), the family, and the clinical support team. Where transplant is considered, the team will need to ensure that there is a good likelihood of compliance with treatment and follow‐up, and there will be in place a robust support package to prevent further attempts at self‐harm. However, current data show that, at least in the medium term, good outcomes can be obtained, although there is a risk of further attempts at self‐harm and of non‐compliance. Although most centers use orthotopic liver transplants, good outcomes have been obtained with auxiliary grafts, which allow for withdrawal of immunosuppression where the native liver recovers.

Keywords: Paracetamol, Acetaminophen, Liver failure, transplantation, outcome
Correspondence: James Neuberger, Organ Donation and Transplantation, NHS Blood and Transplant, Fox Den Road, Bristol, BS34 8RR, UK. e‐mail: James.Neuberger@nhsbt.nhs.uk